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Mar. 2 2010 - 1:11 pm | 1,001 views | 2 recommendations | 12 comments

Vaccine Rhetoric vs. Reality: Pediatrician Q & A

Recent admonishments from Britain’s General Medical Board and the Lancet aside, there is still a vocal sect that believes autism is caused by the MMR vaccine. It’s not only Jenny McCarthy – if you tune in to any parenting website and the topic of vaccines comes up, you can bet the comments will go off the rails at some point during a heated discussion.

The vaccine backlash has real world consequences as we have seen a scary rash of measles and mumps outbreaks around the U.S. and other Western civilizations that have the luxury of being suspicious about inoculations against infectious disease. Wondering how parents are reacting to the recent discrediting of Dr. Wakefield, I talked to a Park Slope, Brooklyn parent and pediatrician, Dr. Philippa Gordon of Gordon & Glaser Pediatrics about how this hot button issue plays out in her office.

As a physician in Brooklyn, home to some of the most vocal parents in the country, your practice must be affected by the debate. I see a lot of heated discussions on parenting message boards, but in reality, how many parents in your practice don’t have their children vaccinated?

I would say probably two percent (2%). The effect of this debate has been not so much that people aren’t vaccinating, but that people want to talk about it a lot more. A large number of parents have devised their own schedules for when they want to vaccinate their own kids.

And you’re open to that in your practice?

I don’t encourage it, but I have to have a parent’s consent to vaccinate their kids. We have some problems with people devising their own schedule for vaccinations because if they come in just to be vaccinated, their insurance company usually won’t pay for that. Reimbursement is a problem because we have to see these kids and we don’t get reimbursed.

I worry a lot when people go on an atypical schedule that we’ll miss something. It just becomes very difficult for us to keep track. You have to be in here with your kid if you don’t want me to follow the recommended routine. You have to be here telling me what you are doing and what you are not doing.

Why is the Brooklyn clientele more vocal on this issue than other groups of parents?

It’s clearly true that in Park Slope and these areas of Brooklyn parents feel that part of their responsibility as a parent is to decide what to do about vaccinations and they really feel they have to make this decision themselves. The doctor knows what’s good in general, but they know what’s best for their kid and their family. It’s a very strong undertone for some people.

Have you seen this trend change over time?

It’s changed. Actually, I think it’s waning a little bit now.

Did the recent disciplinary action and retraction of Wakefield’s study by the Lancet, change any minds?

I think in the past couple of years there have been changes. What’s interesting is another time when I saw a big change in people worrying about vaccines was right after the World Trade Center events. People calmed down about vaccines a lot. Then it rose up again. I feel like it’s all kind of played out.  Everybody is getting over it a little bit.

Did you have any patients who contracted measles during last summer’s outbreak?

No, I didn’t. But one of our patients is radio journalist and she did a story about the outbreak in California. A lot of people came in and talked to me about that story. It seems – in this community, anyway – a lot of people listen to NPR and that story had a strong effect on what people thought. What I’m hearing more of now that I didn’t hear two or three years ago is personal responsibility. That didn’t come into the discussion very much a few years ago and now it’s coming up a lot more that people feel they have a responsibility to vaccinate their kids and that they want other people to vaccinate their kids.

How do you talk to a parent who comes into your office and won’t vaccinate because of the fear of autism?

It’s hard because there’s a lot of misinformation that people are exposed to and it’s scary. We have very, very clear evidence that there is no correlation between any pattern of vaccinating at all and autism. One of the anecdotes that I think people find quite compelling is there was a time in Japan when they couldn’t get any MMR vaccines and for a number of years there was no MMR vaccine available in Japan. During that time the rate of autism continued to rise the same as everywhere else. And of course people like things that happen on an island  – like a little natural experiment. So when you show people the statistics and they see there is no correlation not only between MMR and autism but also between any vaccination pattern and autism that seems to be helpful.

Is it just autism? Or has the fear of vaccines grown into something else?

The fear of vaccines has a symbolic value to parents; fear of the environment, fear of the unknown, fear of big medicine, big pharmacology and big business. People are afraid of big forces acting on their child’s life and taking away control of their child. But very few parents really, really believe you would do something to their child that is harmful. It really is just one to two percent that just can’t bring themselves to vaccinate their child. To me, in families like that the whole vaccination thing has some other meaning. It’s not just about the vaccines. Whatever their parental anxieties are, it’s taking a symbolic form.

Has this fear become prevalent just in the last 15 or so years, or longer?

It actually started before Wakefield and it stared with the pertussis vaccine. What’s interesting to know is when vaccines do have side effects it’s a side effect that is also a side effect of the native disease. So the pertussis vaccine caused high fever and the pertussis germ causes high fever. Then the question was raised about the Guillain-Barre Syndrome and the Swine Flu vaccine because there was an excess of Guillain-Barre Syndrome after the first vaccine under the Carter administration. But the native flu causes more Guillain-Barre. People feel like it’s out of the blue, but it’s not some totally mysterious thing that happens: in every single case when a vaccine is found to have a serious side effect it’s always a side effect of the native disease. Which is sort of comforting.


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    Thank you for this. I feel reassured knowing the non-vaccinators are in the low single-digits. I really like hearing about an uptick in the ‘personal responsibility to the group’ perspective.

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    I don’t believe any doctor would want to harm children. Or any one person out there is planning to do so. I do believe that we as parents have a right to ask as many questions as possible. If there was nothing to worry about then you shouldn’t have to sign a waiver. I am not assuming that autism is caused by vacines. I am also not willing to just go along and pump my children full of whatever they tell you to. Doctors subscribed yaz to millions of woman and now after four years 50 are dead directly from it. who knows how many others had bad side effects. Which leads me to not trust the manufacturers of these products blindly.
    I have not seen all the studies. But I would like to. Like you refered to if you go online you are most likly to come across info from both extremes of the issue. My six month old just went to his app. and got his shots. But we had questions and from here on out we are going to be doing the doctors alternative schedule. My six month old is getting shots that my 4 year old didn’t when he was that age. My 4 year old got shots that I didn’t in the early 80’s. So how are we supposed to know how long or well these drugs have been tested. Not only for autism but other side effects as well. For us with both children we would show up at the doctor, they would hand us a waiver to sign as they were getting the shots ready. When we would ask question we would get treated like some crazy conspericy theorists. I call it being a conserned parent.
    I don’t think that the desire to make an educated decision is a bad thing. I am also not willing to blindly trust companies and industries whos number one priority is profit. 50 woman did that with yaz and now they are dead. By the Yaz is still on the market because it is making them millions. I got my children there vaccines as told up to this point. We also decided to go with a alternative shedule that the doctor has to spread them out a little bit so an infant isn’t being injected with three seperate shots that contain something like 12 seperate vaccines. Do we really need all these new vaccines is a legitamate question. I got the chicken pox and was fine. How many kids had serious complications with chicken pox? How many kids have had serious side effects from the vaccine they now give for chicken pox? These are questions I don’t know the answer to. But shouldn’t I if I am going to sign a consent form for my children to recieve these shots?
    I believe parents should be givin more information either prebirth by the gyno. Or even better at the hospitol. By an independent panel that does not recieve money in any way by hospitols or big pharma. That should also include information on circumcision, which most poeple are misinformed on. That doctor you talked to should offer his own alternative vaccine schedule so he doesn’t have the problems he discussed.
    There is a ploblem with ignoring certain studies. But there isn’t a problem with educating yourself by asking questions and not blindly trusting profit driven companies. Like big pharma.

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    Justin:

    While there are legitimate worries about the intentions of Big Pharma, the evidence of the effectiveness vs. side effects of vaccine is so overwhelming that you don’t need to believe that you’re “pumping” something into your kids. There’s nothing wrong with asking questions, but you also have to accept that your doctor has your best interests at heart. After all, if only for selfish purposes of getting a bad reputation, your doctors does not want to see you or your children harmed.

    And, yes, we do need the new vaccines. Your child, after having chicken pox, can be at risk for having shingles later, for example.

    By the way, the reason you’re handed a waiver for vaccines is BECAUSE so many parents believed that vaccines caused autism or other diseases. It was an unfortunate legal reality for the doctor to protect himself or herself if the patient (incorrectly) blamed a vaccine for causing serious problems.

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      “the evidence of the effectiveness vs. side effects of vaccine is so overwhelming”
      Were is this evidence? I would like to see it. Not because I don’t beleive you but because I want to see it for myself. I would rather see a study and who its by and how its funded. Then to just take the word of somebody online. The main point of my post was that the true information on this kind of stuff should be provided to parents by a credible source. This way they don’t go on the internet looking for it and in the process end up getting misinformed.
      you told me “you also have to accept that your doctor has your best interests at heart”.
      The first line in my post was “I don’t believe any doctor would want to harm children”. Maybe you forgot I wrote that but they seem to have be pretty much the same meaning. Because obvoiusly I AM NOT BLAMING DOCTORS. I just think that doctors overall should help to inform their patients as to what is going on and being done to their children. I think that is a right of the patient. At our visits for the vaccines we recieved on page with a paragraph for every vaccine. I don’t think that is enough. Even you in your post you sort of attacked or talked down to me because I was asking question, which in my opinion is a big part of the problem. I don’t think there is anyting wrong with wanting the best for your kids. So when parents hear that vaccines may be related to autism even though they are misinformed. Could you blame them for not wanting to do something that may harm their children, in their misinformed opinions. For the most part the doctors, at least in my experience, reaction is “oh just trust me” and here is one page worth of information. Since doctors know there is a lot of misinformation out there they should combat that with better information. But until they get paid to do so it probobly won’t happen. I am curious to see how the right would spin it if Doctor were paid by the government to better inform there patients on subjects like vaccines or circumcision or any other subject. They would probobly just put a bunch of talking point together and call a socialist death panel goverment takeover of our right to be free. Never mind thats way to many words for them to remember.

      In response to another comment. See in context »
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    Great post. I’m a firm believer in vaccinations, and feel better knowing that most parents do the responsible thing. I surmise that another reason the debate tends to die down is that parents can’t enroll their children in a public kindergarten without having written evidence from a doctor that the required vaccinations have been given. No shots, no school slot. Be interesting to correlate the people who choose not to vaccinate with those who choose to home school. I bet there’s quite a bit of overlap.

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    I’m not a fan of vaccines. I’m sure I had my share when I was a kid, but as far as the flu shot and swine-flu vaccines, I’ll pass. I’ve never had a flu shot and I’ve never had a serious case of the flu. Perhaps because I never go to the doctor or take medicine I have built up my body’s natural immunities. I’d recommend everyone to go that route. Also, your diet matters, you can’t eat crap and not expect to get sick.

    Vaccines have been proven to have negative side effects, even if the link to Autism is weak. I’d prefer not to get Guillain-Barré syndrome due to a friggn’ flu shot. I’ll fight it off myself, thanks.

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    I am frustrated that the medical establishment has in many cases forced parents to make “all or none” decisions about vaccines. The CDC last year pressured Merck into ceasing production of the individual measles, mumps, and rubella shots. So now I’m forced to either use the combo MMR shot or have my child be completely unvax. I’ve done my homework and the studies “proving” the safety of the combo MMR shot have serious flaws.

    I just want my younger child to have the separate shots the way her brother did just to be on the safe side. It should be MY choice. What gives the government the right to be throwing its weight around and interfering with a private company’s decision to produce FDA-approved vaccines?

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    In the UK GP’s get paid bonuses for the uptake of vaccines, so there is money to be made for encouraging parents to vaccinate their children.

    The Telegraph story discredits the way in which Andrew Wakefield carried out his research. It doesn’t say there is no connection between MMR and autism.

    If vaccines are so effective how do you explain that 77% of the latest Mumps outbreak in New York/New Jersey were vaccinated. http://edition.cnn.com/2010/HEALTH/02/08/mumps.outbreak.northeast/index.html?hpt=T2

    Alice, who does fund The Lancet? I’d be interested to know.

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    About Me

    I fled the tranquil countryside of Oklahoma to become an urban upstart in Manhattan with a stopover in Austin, Texas. After adventures in the music business and the theater, I got hitched, became a mom (to a pre-school lass and a baby boy) and moved to Brooklyn with the rest of ‘em. We all make our choices.

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